Welfare Generosity as a Determinant of Health: Coding State Welfare Laws to Assess Public Health Impact

It is widely understood that inadequate "welfare state generosity" in the United States (leading to increased poverty and inequality) has influenced the US's poor performance in international health comparisons.  However, there are large variations in health status across the United States, and in spite of growing attention to "Health in all Policies," research has been slow to connect the effects of "non-health" legislation on public health outcomes and to examine how redistributive state legislation can influence inequality and poverty to improve the public’s health.  Previous studies have tried to ascertain the direct impact of individual laws, such as Medicaid, WIC18 or AFDC/TANF participation on health outcomes, but such studies have not looked at the overall welfare generosity of a state and its effect on health outcomes.

This study assesses how social welfare generosity (including unemployment insurance, and cash and food assistance programs) influences public health status across states and over time.  By coding state welfare laws, the authors develop a composite index of state welfare generosity between 1990 and 2012, presenting a framework for analyzing how multiple redistributive programs interact to reduce poverty and improve health.  This welfare generosity index provides a means to test the impact of state welfare policy on a range of public health outcomes.  Advancing the field of public health law, such analysis can elucidate the legal factors that give rise to health inequalities, provide evidence of the impact of social policies on health outcomes, and identify specific legal reforms to alleviate health inequality.